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After dropping non-health-insurance businesses, such as life insurance and reinsurance, years ago, the biggest health plans are rediversifying into the money management and banking businesses.

Employer-based health insurance does not appear to be at risk of losing its prime position with health plans, but plans are seeking the health savings account market, and many have started banks to capture it.

Though consumer-directed care has taken off more slowly than projected, the growth of high-deductible health plans paired with HSAs has quickened since 2005. There were about $9.4 billion in HSAs at the end of 2007, according to industry estimates.

"The health insurers would like to not lose that half of the health care wallet," said Charles Boorady, managing director and senior health care analyst for Citigroup, "and one way they're doing that is trying to make banks of their own."

WellPoint, UnitedHealth Group and the BlueCross BlueShield Assn. have FDIC-approved banks that hold HSA balances. But the banking-in-health-care movement is unlikely to end there, experts say.

In a report released in August 2007, Chicago-based Diamond Management & Technology Consultants estimated that the revenue from what its consultants refer to as the "health/wealth" market -- managing such interests as health debit cards -- could reach $40 billion over the next five years.

The authors estimated that $4.3 billion of that $40 billion could be made by companies that help people manage and invest HSAs, particularly as contribution limits rise. The key to profitability, the authors said, is to make money from "asset management," beyond maintenance and transaction fees.

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Proponents of home monitoring devices long have believed that widespread use of those systems can help solve some of the problems plaguing health care today. Now, some technology companies, medical centers, insurers and patients will be testing that theory.

Intel and the Cleveland Clinic announced in recent weeks that they are focusing less on the technology itself than on the ease of its use by the elderly, its role in the continuum of care, and the potential cost savings.

Technology developer Intel announced four separate pilot programs, in partnership with Aetna, SCAN Health Plans in Arizona, Erickson Retirement Communities and Advanced Warning Systems. The Cleveland Clinic is conducting a pilot with Microsoft HealthVault.

Home monitoring provides a way for patients to use electronic devices to collect their own health data, such as vitals or glucose levels. The devices can then be linked with a computer, allowing data to be transmitted to the health care team or to an accessible data repository.

Ray Askew, spokesman for Intel, said each of its pilot sites will focus on a specific chronic condition. Each partner will choose its own participants, with the pool likely to be made up mostly of elderly patients.

One of the biggest questions with home monitoring devices is whether the elderly, the population from which the most benefits could potentially be gained, will actually use the technology.

Askew said ease of use has been one of the key consumer research areas for Intel. Several modifications, such as limited functionality and large buttons, were made to make the systems easier to use.

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A survey released Dec. 4 by the Center for Studying Health System Change had findings similar to those of a Harris Interactive Poll released in June: A vast majority of Americans prefer word of mouth when choosing a new doctor or hospital, despite a drive to post doctor cost and quality information online.

The survey found 10.8% of patients look to online ratings sites to find a primary care physician, while 50.3% rely on friends or relatives, 38.1% on doctors or other health care personnel, and 34.7% on health plans.

For specialists, 6.8% of patients use online ratings sites, 68.5% seek referrals from their primary care physician, 19.9% rely on friends, 18% on another doctor and 10.5% on health plans. The Harris poll found 22% of patients looked at physician rating sites in 2007, and only 2% changed doctors as a result of what they found on a ratings site.

"The reality is most people have long relied on word of mouth to choose their physicians, and that is still the case," center spokeswoman Alwyn Cassil said.

Maribeth Shannon, director of the marketing and policy program for the California HealthCare Foundation, a proponent of online physician ratings sites, said information revealed by the center showed one possible reason why so few patients are investigating doctors online -- only a minority were in the market for a new doctor.

The center's Health Tracking Household Survey found that only 11% of patients looked for a new primary physician in 2007, 28% needed a new specialist and 16% underwent a medical procedure at a new facility. The national survey contained information on 13,500 adults and had a 43% response rate.

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There were only 30 seconds from the time the radio announced a tornado sighting until the 180 mph twister pummeled the medical office, removing the roof and destroying the front part of the building.

Ronald Simpson, MD, crouched under three desks while the storm ripped through his office, the neighboring hospital and the community of Mountain View, Ark.

"I couldn't see anything. What sounded like the loudest hail I ever heard in my life was actually debris flying," the family physician said. "When the storm was over, I crawled out and saw my car had been blown away and a new Chevy was in its place. The two-story portion of my building was gone. Two wings at the hospital behind it were gone."

His 40 seconds of terror was part of a multistate outbreak dubbed the Super Tuesday tornadoes, because they struck Feb. 5, the same day 24 states held their presidential primaries.

The aftermath lingers. Dr. Simpson and administrators at the Stone County Medical Center are facing two years' of disruption and hundreds of thousands of dollars in expenses before their buildings are fully restored.

Dr. Simpson believes his road to recovery would have been clearer if he had had a preparedness plan.

A disaster plan is a set of procedures that clearly dictates what has to be done, when and by whom, before and after a disastrous event, whether a hurricane, fire, or broken water pipe.

This is not a simple evacuation plan. Rather, it is a systematic preparation for coping, including having proper insurance, medical record protection, procedures for staff response, and a procedure for contacting patients, said Carol Chastang at the U.S. Small Business Administration Office of Disaster Assistance. These emergency procedures should be documented and the staff should be made aware of them.

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Chances are, before your patients come to you with flu-related symptoms, they have already done an online search about them.

That is the assumption behind a new tool launched by Google, the search engine company that has been expanding into health care over the past few years, including launching an online personal health record.

Google Flu Trends, launched in November, collects the aggregate data for flu-related search terms to pinpoint specific areas of flu outbreak. Unlike reports from the Centers for Disease Control and Prevention, which normally take a few weeks to compile and release, Google flu data are updated daily.

The company says the service could alert physicians and public health officials when an influenza outbreak has occurred. The CDC is collaborating with Google on the Flu Trends project.

"The CDC and state Web sites are weeks or up to a month late on reporting trends, so they are more useful for historical data as opposed to making decisions at the time you look at [the data]," said George Voigtlander, MD, a family physician with Pawnee County Rural Health in Pawnee City, Neb.

Google says the tool uses aggregate data from hundreds of millions of searches over time to come up with estimated percentages of people with influenza-like illnesses. The data are updated daily and can be accessed by anyone online (www.google.org/flutrends).

The Web page displays a map that shows specific information for each state, along with a fever chart that shows historical flu outbreak data for that region and time.

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